Abstract
.Significance: One key pathological characteristic of seronegative spondyloarthropathy (SpA) is inflammation at the insertion of tendons and ligaments into the bone (enthesitis).Aim: We explore the potential of the emerging photoacoustic (PA) imaging in diagnosis of SpA and review its feasibility in detecting SpA-associated Achilles tendon enthesitis.Approach: A light-emitting diode (LED)-based PA and ultrasound combined system was employed. The PA images, both along the long and the short axes of each Achilles tendon insertion region, were acquired at 850-nm wavelength, which is sensitive in depicting increased blood volume (i.e., hyperemia). To assess the hyperemia indicating enthesis inflammation, two parameters were quantified in the imaged tendons, including the average intensity and the density of the color pixels in the pseudo-color PA images. Ten SpA patients, all of which met Assessment of SpA International Society (ASAS) criteria for SpA and were found to have Achilles enthesitis by clinical exam according to a board-certified rheumatologist, were included in the study.Results: The PA and Doppler ultrasound imaging of Achilles enthesitis resulting from these 10 SpA patients were compared to those from 10 healthy volunteers, leading to statistically significant differences () in the applied -tests.Conclusions: This preliminary clinical study suggests that the LED-based PA imaging holds a promise for sensitive and objective assessment of SpA enthesitis in an outpatient setting of the rheumatology clinic.
Highlights
Seronegative spondyloarthropathies (SpA) [psoriatic arthritis (PsA), Ankylosing spondylitis (AS), reactive arthritis (ReA), arthritis associated with inflammatory bowel disease (IBD), and undifferentiated spondyloarthritis] are a heterogeneous family of inflammatory arthritides characterized by Assessment of SpondyloArthritis international Society (ASAS) as having
SpA treatment is challenged by reduced imaging sensitivity at early stages of pathology conditions, where symptoms are nonspecific and emerging after radiographic progression occurs, and the average time from onset of symptoms to diagnosis can be as long as 10 years.[4]
The enthesis inflammation detected by PA imaging was confirmed by the Doppler US imaging, which showed active Doppler signals both along and across the entheses, the Doppler signals along the entheses were not as strong
Summary
Seronegative spondyloarthropathies (SpA) [psoriatic arthritis (PsA), Ankylosing spondylitis (AS), reactive arthritis (ReA), arthritis associated with inflammatory bowel disease (IBD), and undifferentiated spondyloarthritis (uSpA)] are a heterogeneous family of inflammatory arthritides characterized by Assessment of SpondyloArthritis international Society (ASAS) as havingJournal of Biomedical OpticsDownloaded From: https://www.spiedigitallibrary.org/journals/Journal-of-Biomedical-Optics on 08 Nov 2021 Terms of Use: https://www.spiedigitallibrary.org/terms-of-useDecember 2020 Vol 25(12)Jo et al.: Imaging of enthesitis by an LED-based photoacoustic system inflammatory back pain, presence of enthesitis, dactylitis, and a variety of other extraarticular manifestations. PsA affects about 30% of patients with psoriasis in the United States.[1,2,3] Early SpA treatment is challenged by reduced imaging sensitivity at early stages of pathology conditions, where symptoms are nonspecific and emerging after radiographic progression occurs, and the average time from onset of symptoms to diagnosis can be as long as 10 years.[4] The lack of early diagnosis of SpA is due to limited pathognomonic clinical technology in specific imaging of the biomarkers of the disease. Unlike RA-related synovitis, enthesitis is more challenging to detect with ultrasound (US) imaging. Emerging clinical research on SpA has been focused on studies that identify or validate biomarkers that are sensitive to early diagnosis and disease progression and early responses to therapy
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